My Back Recovery: Recovering from Chronic Low Back Pain

In every episode we share valuable insights from systematic research and clinical guidelines, as well as advice from experts dedicated to helping people recover from chronic low back pain. My Back Recovery promotes evidence based treatment options, safe training and expert strategies to help you make smart decisions about your rehabilitation process.
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My Back Recovery: Recovering from Chronic Low Back Pain




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Now displaying: November, 2016
Nov 8, 2016

The second part of episode six takes a tour into the scientific world of clinical research, exploring how clinical guidelines are created and looking at why they are important.

Clinical guidelines promote evidence-based practice by giving out recommendations according to available evidence from systematic research and can therefore have a great impact on your recovery plan.


How is a guideline formed?

Firstly a vast amount of scientific literature is systematically searched from within clinical databases and then checked for relevance.

The next step critically grades all the studies according to their methodological quality (a very good study has more impact than a study with potential for bias).

These steps are usually all undertaken parallel by at least two people and then the results are compared. These findings are then finally summarized and recommendations are drawn.

If you want to take a closer look into the world of research, I recommend you check out the Grade Handbook on the webpage. This is a good in-depth explanation how guidelines are created.
The handbook can also be found through the Internet by searching for "Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach".


Selecting the best information available when creating a guideline

Every single study that contributes to a guideline or systematic review, is a scientific piece of work with high standards (some higher or lower, hence the grading system).

Therefore scientists and researchers try hard to control every little detail within their studies and here are a couple of examples of how they do that:


If you want to find out if strength-training works for people with LBP you can’t just ask people with LBP to sign up for a strength-training class because this could result in selection bias: Only people who believe in strength training would participate, and this group of people is not representative for the average LBP-patient.

The group has to be selected from real patients with LBP ideally randomly assigned to one of two groups, a strength-training group and a control group.

In order to control the study results for a placebo effect, both groups should undergo active intervention of equal activity time. For example the control group could undertake a stretching routine.

Wherever possible the patients should not know which group they are in (this is called blinding of patients). The therapists should also not be aware which group is which, this is because it could also have an effect on the treatment outcome! (Don’t believe me? Check out the "rosenthal- or hawhorne- or helo-effect). This is however not always possible, but would be the ideal.

The ‘blinding’ should also include those recording and adjudicating the outcomes for both groups.

Furthermore the endpoint of the study should be defined in advance. The study must always continue up to the predefined end, neither lengthened nor shortened as this can lead to a distortion of the results.

As positive study results are more likely to be published, researchers searching of systematic reviews try to evaluate possible publication bias. For example, if a study is sponsored by a specific company or industry the results could be considered biased and the evidence is down graded.


Why is it important to read guidelines?

Researchers know about all the problems mentioned above, and they also try to tackle them in the best possible ways.

I think it is really important to be informed and know about the limitations of research and at the same time value its results, since it’s the only real evidence, along with your own personal experience, and the personal experience of the medical professionals trying to be of service to you, that you have in helping you make an informed decision about which treatment to take.


All in all a lot of effort goes into the creation of a guideline!

Find out more:

Nov 8, 2016

Recommendations based on current available evidence helps you combine your personal experience and expectations with research to form an individual treatment plan and find treatments with the most promising results.


What treatment should I consider for my back pain? 

There are many guidelines regarding LBP and some even especially for chronic LBP.

In this episode you will find information about the treatment options often recommended in these guidelines.


Setting evidence into your personal situation

After having examined all the best available evidence from systematic research it is important to know how to apply this information to your individual situation.

Evidenced based treatment is more than simply the best available evidence from systematic research alone.

It should also take into account the expertise of your clinician(s) as well as your personal expectations, beliefs and preferences!1,2,3


Treatment Recommendations with strong supporting evidence

  • Information, education and self-care

"All the guidelines explicitly underline the importance of educating and providing patients with information on LBP with regard to their expected course and the possibility of effective prevention and selfcare options."4

  • Physical activity and therapeutic exercise

"There is strong evidence that physical activity and therapeutic exercise are effective for the management of CLBP, even if it is not clear what kind of exercise is best. An individual, graded and active exercise program supervised by an expert (physical therapist) is almost always recommended."4

  • Multidisciplinary treatment programs

"Combined physical and psychological interventions with cognitive-behavioral therapy and exercise are particularly recommended for people who have received at least one course of less intensive treatment and have high disability and/or significant psychological distress."4


All other forms of treatment are currently categorized using the following descriptions:

Might do - recommendations with moderate supporting evidence

Don’t know - recommendations with limited or inconclusive evidence

Don’t do - recommendations with strong evidence against intervention


For more information of other treatment options please refer to the original article which can be found via the Internet: "An updated overview of clinical guidelines for chronic low back pain management in primary care."4


Find out more:




  1. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007;455:3–5. Available at: Accessed December 16, 2012.
  2. Manske RC, Lehecka BJ. Evidence - based medicine/practice in sports physical therapy. Int J Sports Phys Ther. 2012;7(5):461–73. Available at: Accessed December 16, 2012.
  3. Jette DU, Bacon K, Batty C, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786–805. Available at: Accessed October 5, 2012.
  4. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Jt Bone Spine. 2012;79(2):176–185. doi:10.1016/j.jbspin.2011.03.019.